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Letter to the Editor   |    
Antidepressant-Induced Sexual Dysfunction and Ginkgo Biloba
ADAM KELLER ASHTON, M.D.; KRISTIN AHRENS, M.D.; SANJAY GUPTA, M.D.; PRAKASH S. MASAND, M.D.
Am J Psychiatry 2000;157:836-837. doi:10.1176/appi.ajp.157.5.836

Sexual dysfunction is a common consequence of treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants (1, 2). Antidote strategies are often used to lessen the sexual difficulty associated with these agents. A variety of medications are reported to reverse SSRI-induced sexual dysfunction. These include cyproheptadine (1, 3, 4), yohimbine (1, 5, 6), amantadine (1, 7, 8), stimulants (9), buspirone (10), bupropion (11, 12), and sildenafil (1315). In addition, ginkgo biloba has been used to treat antidepressant-induced sexual dysfunction (16). Although the study of gingko biloba had numerous limitations, including problematic statistical analyses (17, 18), it raised hope that ginkgo biloba could be helpful in managing SSRI-induced sexual dysfunction. We report here our experience with use of ginkgo biloba in reversing SSRI-induced sexual dysfunction.

A 1-month trial of ginkgo biloba was prescribed for 22 consecutive patients (nine men and 13 women) seen in a private psychiatric office who complained of SSRI-induced sexual dysfunction. The gingko biloba was purchased at a local health store, and the prescribed dose was 300 mg t.i.d. Oral consent was obtained; written consent was not obtained because the results of this study were not initially for publication. SSRI-induced sexual dysfunction was defined as a new impairment in sexual desire, arousal, or orgasm appearing within 4 weeks of beginning treatment with an SSRI. Ratings of improvement were based on clinical interviews by the patient’s treating psychiatrist.

The 22 patients enrolled in this study described 40 sexual complaints. Three (13.6%) of the 22 patients described at least partial improvement in sexual function while taking ginkgo biloba. None of the nine men and three (23.1%) of the 13 women described improved sexual response. In addition, four (10.0%) of the 40 complaints improved with ginkgo biloba treatment. When analyzed by sex, none of the nine complaints of the men and four (12.9%) of the 31 complaints of the women improved. No side effects of ginkgo biloba treatment were reported.

This brief study demonstrates little reversal of SSRI-induced sexual dysfunction from treatment with ginkgo biloba. There are several obvious limitations to this study, including the lack of a placebo control, a potential variation in product potency, a selection bias, and the lack of a standardized outcome measure. Ginkgo biloba may still hold hope for some patients, perhaps with the selection of a particular brand of product, the use of a higher dose, or use for a longer duration. Nevertheless, this study does not replicate prior findings supporting the use of ginkgo biloba for the treatment of SSRI-induced sexual dysfunction.

Ashton AK, Hamer R, Rosen RC: Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large scale retrospective study of 596 psychiatric outpatients. J Sex Marital Ther  1997; 23:165–175
[PubMed]
[CrossRef]
 
Montejo-Gonzalez AM, Llorca G, Izquierdo JA, Ledesma A, Bousono M, Calcedo A, Carrasco JL, Ciudad J, Daniel E, De la Gandara J, Derecho J, Franco M, Gomez MJ, Macias JA, Martin T, Perez V, Sanchez JM, Sanchez S, Vicens E: SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther  1997; 23:176–194
[PubMed]
[CrossRef]
 
McCormick S, Olin J, Brotman AW: Reversal of fluoxetine-induced anorgasmia by cyproheptadine in two patients. J Clin Psychiatry  1990; 51:383–384
[PubMed]
 
Feder R: Reversal of antidepressant activity of fluoxetine by cyproheptadine in three patients. J Clin Psychiatry  1991; 52:163–164
[PubMed]
 
Jacobsen FM: Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J Clin Psychiatry  1992; 53:119–122
[PubMed]
 
Hollander E, McCarley A: Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers. J Clin Psychiatry  1992; 53:207–209
[PubMed]
 
Balogh S, Hendricks SE, Kang J: Treatment of fluoxetine-induced anorgasmia with amantadine (letter). J Clin Psychiatry  1992; 53:212–213
[PubMed]
 
Shrivastava RK, Shrivastava S, Overweg N, Schmitt M: Amantadine in the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors (letter). J Clin Psychopharmacol  1995; 15:83–84
[PubMed]
[CrossRef]
 
Bartlik BD, Kaplan P, Kaplan HS: Psychostimulants apparently reverse sexual dysfunction secondary to selective serotonin reuptake inhibitors. J Sex Marital Ther  1995; 4:264–271
 
Norden MD: Buspirone treatment of sexual dysfunction associated with SSRI"s. Depression  1994; 2:109–112
[CrossRef]
 
Labbate LA, Pollack MH: Treatment of fluoxetine-induced sexual dysfunction with bupropion: a case report. Ann Clin Psychiatry  1994; 6:13–15
[PubMed]
[CrossRef]
 
Ashton AK, Rosen RC: Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry  1998; 59:112–115
[PubMed]
[CrossRef]
 
Nurnberg HG, Lauriello J, Hensley PL, Parker LM, Keith SJ: Sildenafil for iatrogenic serotonergic antidepressant medication-induced sexual dysfunction in 4 patients. J Clin Psychiatry  1999; 60:33–35
[CrossRef]
 
Ashton AK, Bennett RG: Sildenafil treatment of serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry  1999; 60:194–195
[PubMed]
[CrossRef]
 
Ashton AK: Sildenafil treatment of paroxetine-induced anorgasmia in a woman (letter). Am J Psychiatry  1999; 156:800
 
Cohen AJ, Bartlik B: Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther  1998; 24:139–143
[PubMed]
[CrossRef]
 
Balon R: Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther  1999; 25:1–2
[PubMed]
 
Levine SB: Caution recommended. J Sex Marital Ther  1999; 25:2–5
[PubMed]
 
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References

Ashton AK, Hamer R, Rosen RC: Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large scale retrospective study of 596 psychiatric outpatients. J Sex Marital Ther  1997; 23:165–175
[PubMed]
[CrossRef]
 
Montejo-Gonzalez AM, Llorca G, Izquierdo JA, Ledesma A, Bousono M, Calcedo A, Carrasco JL, Ciudad J, Daniel E, De la Gandara J, Derecho J, Franco M, Gomez MJ, Macias JA, Martin T, Perez V, Sanchez JM, Sanchez S, Vicens E: SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther  1997; 23:176–194
[PubMed]
[CrossRef]
 
McCormick S, Olin J, Brotman AW: Reversal of fluoxetine-induced anorgasmia by cyproheptadine in two patients. J Clin Psychiatry  1990; 51:383–384
[PubMed]
 
Feder R: Reversal of antidepressant activity of fluoxetine by cyproheptadine in three patients. J Clin Psychiatry  1991; 52:163–164
[PubMed]
 
Jacobsen FM: Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J Clin Psychiatry  1992; 53:119–122
[PubMed]
 
Hollander E, McCarley A: Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers. J Clin Psychiatry  1992; 53:207–209
[PubMed]
 
Balogh S, Hendricks SE, Kang J: Treatment of fluoxetine-induced anorgasmia with amantadine (letter). J Clin Psychiatry  1992; 53:212–213
[PubMed]
 
Shrivastava RK, Shrivastava S, Overweg N, Schmitt M: Amantadine in the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors (letter). J Clin Psychopharmacol  1995; 15:83–84
[PubMed]
[CrossRef]
 
Bartlik BD, Kaplan P, Kaplan HS: Psychostimulants apparently reverse sexual dysfunction secondary to selective serotonin reuptake inhibitors. J Sex Marital Ther  1995; 4:264–271
 
Norden MD: Buspirone treatment of sexual dysfunction associated with SSRI"s. Depression  1994; 2:109–112
[CrossRef]
 
Labbate LA, Pollack MH: Treatment of fluoxetine-induced sexual dysfunction with bupropion: a case report. Ann Clin Psychiatry  1994; 6:13–15
[PubMed]
[CrossRef]
 
Ashton AK, Rosen RC: Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry  1998; 59:112–115
[PubMed]
[CrossRef]
 
Nurnberg HG, Lauriello J, Hensley PL, Parker LM, Keith SJ: Sildenafil for iatrogenic serotonergic antidepressant medication-induced sexual dysfunction in 4 patients. J Clin Psychiatry  1999; 60:33–35
[CrossRef]
 
Ashton AK, Bennett RG: Sildenafil treatment of serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry  1999; 60:194–195
[PubMed]
[CrossRef]
 
Ashton AK: Sildenafil treatment of paroxetine-induced anorgasmia in a woman (letter). Am J Psychiatry  1999; 156:800
 
Cohen AJ, Bartlik B: Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther  1998; 24:139–143
[PubMed]
[CrossRef]
 
Balon R: Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther  1999; 25:1–2
[PubMed]
 
Levine SB: Caution recommended. J Sex Marital Ther  1999; 25:2–5
[PubMed]
 
+
+

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